Capitol Hill Report: Health Debate Starts in the House; Delayed in the Senate

July 21, 2009

The mission of the Academy is to be "indispensable to its members." One way the Academy fulfills this mission is by representing of neurology in the halls of Congress. Capitol Hill Report presents regular updates on legislative action and how the AAN ensures that the voice of neurology is heard on Capitol Hill. The Academy's legislative counsel in Washington, DC, Mike Amery, offers weekly updates on advocacy for neurology and neurologic concerns.

Update: July 23

The Associated Press is reporting that Senate Majority Leader Harry Reid (D-NV) has said the Senate will not be voting on a health care bill until sometime this fall.

As I write this we are still awaiting details of their legislation.

What a thrilling time to be on Capitol Hill! The House Democrats are pushing for health care reform, the Republicans are screaming "nationalized health care," the President wants a bill by the August recess, and the Sen. Finance Chair Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) are still trying to put a bipartisan deal together but keep pushing the deadline back because of disagreement. Moderate Senators are asking to slow down the process. The AMA is supporting the House bill, but state medical associations across the country are defying the AMA by sending a letter in opposition, mainly because of the plan to have a public insurance option.

First, the update

House: Three Congressional House committees began marking up health reform bills last week. In a mostly party-line vote, the House Ways & Means Committee voted 23–18 to approve the House's recently released health reform legislation after voting down 35 Republican-sponsored amendments. Just three Democrats—Reps. Ron Kind (WI), Earl Pomeroy (ND), and John Tanner (TN)—joined every Republican on the panel in voting against the bill. The Energy & Commerce (E&C) and Education & Labor Committees will continue debate this week.

The House committee markups on Thursday were quickly dealt a significant blow. Congressional Budget Office (CBO) Director Douglas Elmendorf said during a committee hearing that congressional Democrats' health care reform proposals do not include "the sort of fundamental changes" needed to curb the rising cost of government health programs, particularly Medicare. Elmendorf said that the House Democrats' bill would add more than $1 trillion to federal health spending over the next decade while cutting about $500 billion from existing proposals. As you might expect, this will make passage of the House bill very difficult for members of the Senate who are trying to "bend the cost curve" of health care.

Senate: The Senate HELP Committee passed a bill early in the week, but it is widely expected that the main Senate effort will be from the Finance Committee, which controls the money. Finance Committee members have not been able to reach an agreement, which pushes introduction of their bill until at least this week. As discussed last week, the Academy continues to press the Senate to include neurology as a specialty eligible for bonuses for evaluation and management care.

Pascrell, Matheson, Shadegg

Throughout the week I met with members of Congress to discuss health reform as a whole and also neurology's positions. I got a great deal of different information from members depending on their point of view. A few that stood out were Bill Pascrell (D-NJ), a seven-term member from Paterson, NJ, who won his last race with 71 percent of the vote. Pascrell told a group of medical specialty representatives including myself, "Come hell or high water we are going to break the status quo! We are far away from the goal line, but we are going to get over it."

This was followed at a different meeting by Blue Dog Coalition and E&C member Jim Matheson (D-UT), who has competitive re-election races every two years. "I don't know what these guys are thinking . . . they're raising taxes by $500 billion! I don't care who the taxes come from, they just aren't attached to the realities of a district like mine. I think it must be since the three committee chairmen haven't had competitive elections since the 1970s."

Then there was the Republican point of view from E&C member John Shadegg (R-AZ), who was incredulous at a recent event I attended in describing how the cost of the bill in front of the committee was determined. "How many times have we seen this? The Democrats create something they haven't paid for or underestimated its cost?" said Shadegg. "The CBO scored this, not on a review of the legislation, but on discussions with staff. This is sure to cost much more than they anticipate. The point is that if you like your health care, forget it, you won't be able to keep it as employers drop health care." Shadegg was referring to the bill's provision that employers will pay an eight-percent penalty, based on payroll, for not providing health insurance coverage for employees. The penalty kicks in for any business with more than $250,000 in payroll.

Lastly, I met with Earl Blumenauer (D-OR). Blumenauer is a Ways & Means Committee member who voted in favor of final passage in the committee. Blumenauer expressed his support for the bill and, in front of several specialties associations, discussed how the bill eliminates the flawed physician reimbursement formula know as the Sustainable Growth Rate or "SGR." The elimination of the SGR has been a top federal priority for the Academy for many years. This would be a true benefit to all physicians who provide care to Medicare beneficiaries. Blumenauer said he understands some of the questions that are being raised, but there is no question that the current system is broken and that big steps need to be taken to ensure that Americans receive higher quality care in a more rational system.

For the last several weeks, I have talked about how the 58 fiscally conservative Democrats who are members of the Blue Dog Coalition hold the keys to health care reform. Ten of them sit on the E&C Committee and, as of this writing, all ten are "no" votes on health reform. Something will have to change, either the bill or the Blue Dogs. The Blue Dogs are demanding changes. When asked, Shadegg said the Blue Dogs will fold.